A standardized discharge process in a pediatric emergency department eliminated preventable discharge-related serious safety events and increased vital sign acquisition from 67% to 83%.
Does a standardized discharge process improve discharge safety and reduce serious safety events in a pediatric emergency department?
Implementing a standardized discharge process in a pediatric emergency department eliminated reported discharge-related serious safety events without increasing length of stay or return visits.
BACKGROUND AND OBJECTIVES: Discharge from the emergency department (ED) involves a complex series of steps to ensure a safe transition to home and follow-up care. Preventable, discharge-related serious safety events (SSEs) in our ED highlighted local vulnerabilities. We aimed to improve ED discharge by implementing a standardized discharge process with emphasis on multidisciplinary communication and family engagement. METHODS: At a tertiary children's hospital, we used the model for improvement to revise discharge care. Interventions included a new discharge checklist, a provider huddle emphasizing discharge vital signs, and a scripted discharge review of instructions with families. We used statistical process control to evaluate performance. Primary outcomes included elimination of preventable, discharge-related SSEs and Press Ganey survey results assessing caregiver information for care of child at home. A secondary outcome was number of days between preventable low-level (near-miss, no or minimal harm) events. Process measures included discharge checklist adoption and vital sign acquisition. Balancing measures were length of stay (LOS) and return rates. RESULTS: Over the study period, there were no preventable SSEs and low-level event frequency improved to a peak of >150 days between events. Press Ganey responses regarding quality of discharge information did not change (62%). Checklist use was rapidly adopted, reaching 94%. Vital sign acquisition increased from 67% to 83%. There was no change in the balancing measures of median LOS or return visit rates. CONCLUSIONS: The development and implementation of a standardized discharge process led to the elimination of reported discharge-related events, without increasing LOS or return visits.
Paydar‐Darian et al. (Wed,) conducted a other in Pediatric emergency department discharge. Standardized discharge process vs. Pre-intervention standard of care was evaluated on Elimination of preventable, discharge-related serious safety events (SSEs) and Press Ganey survey results assessing caregiver information. A standardized discharge process in a pediatric emergency department eliminated preventable discharge-related serious safety events and increased vital sign acquisition from 67% to 83%.